Name of Employer: Life Limited Reg No. 1997/022561/06 FAIS Licence no: 1178 Place, 61 Katherine Street, Sandown, 2196 P O Box 652071, Benmore, 2010 Tel:+27 0860 100 333 (call centre) Fax:+27 (11) 324 3461 (call centre) Name of Paypoint (if more than one): WITHDRAWAL NOTIFICATION MEMBER S PARTICULARS (please complete in full) Surname First names Maiden name ID/Passport number Country of issue Date of birth D D M M Y Y Y Y Residential address* Unit number Complex Street number Street/Farm name Suburb City/Town Country Code Postal address* Telephone numbers Home C O D E N U M B E R Work C O D E N U M B E R Code Cell E-mail Employee number Date of employment D D M M Y Y Y Y Date of withdrawal D D M M Y Y Y Y Date of last contribution D D M M Y Y Y Y Annual salaries at date of withdrawal Taxable R, Pensionable R, Period of employment outside RSA prior to withdrawal Completed years From D D M M Y Y Y Y to D D M M Y Y Y Y Income tax number* Revenue office * Non-completion of these will result in a delay in the settlement of this claim. REASON FOR WITHDRAWAL (tick appropriate box) () Resignation Dismissal Retrenchment (Voluntary) Retrenchment (Involuntary) IS THERE A DIVORCE OR MAINTENANCE COURT ORDER ISSUED AFFECTING THE PAYMENT OF FUND BENEFITS? Yes No If yes, please provide a copy of the court order. INDEBTEDNESS TO EMPLOYER TO BE RECOVERED FROM BENEFITS (DEDUCTIONS AS PER SECTION 37D OF THE PENSION FUNDS ACT) Section 37D of the Pension Funds Act R, The section provides two instances when a fund may deduct amounts from a member s benefit. These are: 1. When the member owes the fund or his employer money for an outstanding housing loan given by the fund or the employer or where the fund or employer provided a guarantee for a housing loan taken by the member and the guarantee is enforced. 2. In the event of an employer suffering loss due to an employee s theft, dishonesty, fraud or misconduct, where the employee has admitted liability in writing or a court judgement has been obtained. In such instances, a copy of the court order must be attached. Copyright in this material is expressly reserved and this form and all attachments (where applicable) remains the exclusive property of. This form and all attachments (where applicable) may not be copied, stored, retrieved or in any way reproduced without the express written permission of. Breach of copyright is a serious offence and can lead to litigation. 2770 WDL-AFRF2009/11
PAYMENT INSTRUCTIONS If the member is unsure of whether he wants to take the cash or to preserve the money he may want to consider transferring to the AFRF Preservation Section until such time as he has made a decision. We wish to draw to your attention the fact that if the member does not sign an application form to join a Preservation Fund (whether the AFRF Preservation Fund or any other Preservation Fund) prior to the date of his exit the current regulations prohibit him from joining a Preservation Fund. The advantages of electing this option are; 1. His money can remain fully invested, or alternatively he could switch into the banker portfolio and he may earn a higher rate of interest than if the money were to remain in the AFRF bank account; 2. the member can still elect to take a cash benefit at a later date if he so wishes (refer to the Retirement Fund (Preservation Section) Disclosure Withdrawal Benefits); 3. the member can still elect to transfer to another preservation fund when he is ready to make a decision (refer to the Retirement Fund (Preservation Section) Disclosure Transfers out of the AFRF (Preservation Section)); Please note that the above statement is not intended to be advice as contemplated in terms of the Financial Advisory and Intermediary Services Act of 2002. For more information about this option please contact the Individual Advice Centre on 0860 100 983. Please complete the relevant sections of this withdrawal notification form as set out below. 1. Full benefit to be transferred to AFRF (Preservation Section) Complete Part A - AFRF (Preservation Section) overleaf in full 2. Full benefit to be transferred to another approved fund Complete Part B - Transfer section overleaf in full 3. Full benefit to be paid to member in cash Complete Part C - Cash Benefit section overleaf in full 4. Part transfer to another approved fund and part benefit to member Complete both Part B - Transfer and Part C - Cash Benefit sections overleaf in full If the member requires financial planning assistance they can contact the Individual Advice Centre who will advise members of their options when withdrawing. Tel number: 0860 100 983 If provided by the fund does the member wish to exercise any continuation option? Yes No If yes, kindly contact the Financial Planning Consultants on 011 269 0115 for assistance in exercising this option. MEMBER S SIGNATURE & DISCHARGE I hereby confirm that: payment of my benefit as specified herein represents the full and final discharge of the fund s liability to me; the details provided herein, in particular my banking details (if applicable) are true and correct in every way; I understand the options available to me with regard to the payment of my benefits, including the inherent tax implications and that I am making an informed choice; in the event of any loss suffered as a result of any details provided herein being incorrect, neither the fund nor can be held liable for such losses. I understand that I have the right to amend the payment instruction to and that may levy a fee for acting on any amended payment instruction after my initial payment instruction has been actioned. I acknowledge that my benefit will be disinvested and held in the Fund s bank account until such time as payment of the benefit is made in terms of my payment instructions. The only exception to this practice will be where the money is to be transferred to the AFRF (Preservation Section), or the Administrator is instructed in writing not to disinvest the monies or where a separate agreement is in place on the Fund in terms of the disinvestment of exit benefit monies. I understand that in terms of legislation, any benefit which is due to me and which has not been paid within 24 months from the date it first became due in terms of the Rules of the Fund will become an Unclaimed Benefit and will be transferred to an Unclaimed Benefit Fund. Member s signature Date EMPLOYER S DECLARATION It is hereby confirmed and warranted that the information contained herein is correct and, in particular, that the member s banking details provided on page 5, part C, have been confirmed as correct; the Employer has provided the member with a copy of the Options available to members on leaving their Retirement Fund document and/or with the contact details for the Individual Advice Centre; the Employer will endeavour to ensure the member signs this notification; in cases where the member does not sign the notification, the Employer shall sign on behalf of the member. The Employer hereby unconditionally absolves the Fund and and as necessary indemnifies and keeps indemnified the Fund and from and against all and any loss, damage, costs and expenses which the beneficiaries, or any other person whatsoever, may sustain or incur, either directly or indirectly as a result of, on behalf of the Fund, relying on and using any information supplied by the Employer, specifically where the Employer has failed to obtain the beneficiary s signature on this notification. Employer s stamp Authorised signature Name (Print) Designation Contact number Date
Part A TRANSFER TO AFRF (PRESERVATION SECTION) (A) TRANSFER TO AFRF (PRESERVATION SECTION I elect to transfer my withdrawal benefit to the Retirement Fund (Preservation Section) by signing the section below. I acknowledge that the terms contained in this block are binding between myself and the Retirement Fund (Preservation Section) and its administrators AF Life Limited. In selecting this option I acknowledge the following: 1. I have read and understood the AFRF (Preservation Section) disclosures contained overleaf, and I consider myself bound by the Rules and policies of the AFRF (Preservation Section), as amended, copies of the Rules and policies are available at the offices of ; Agree Disagree 2. 3. 4. 5. 6. 7. I understand that in the event that I require professional financial planning advice to ensure that this product meets my needs I should approach a financial advisor. I confirm that AF Life has not provided me with any advice as to the suitability of this product; I confirm that this document will form part of my contract for participation in the AFRF (Preservation Section); I acknowledge that if part of the benefit is taken in cash to settle a Section 37D deduction in so far as it relates to Divorce / Maintenance Benefits, then the balance of the benefit may be transferred to the AFRF (Preservation Section) and the deduction will not be regarded as a first withdrawal. For any other 37D deductions e.g. housing loan, dishonesty, fraud, etc., the deduction will be regarded as a first withdrawal from the AFRF (Preservation Section). I have been made aware that if I have an outstanding HomePlan loan I could cede it to the AFRF (Preservation section) subject to the terms described in the HomePlan transfer form; I have attached a copy of my ID document or passport; I acknowledge that should I disagree with any of the above statements, or should this form not be completed in full, my transfer to the AFRF (Preservation Section) will not take place. (B) ONGOING ADVICE MANDATE ENTERED INTO WITH ALEXANDER FORBES FINANCIAL PLANNING CONSULTANTS (PTY) LTD (herein referred to as FPC) 1. 2. 3. 4. 5. 6. 7. 8. 9. I hereby appoint FPC as my financial advisors to provide me with ongoing investment advice in respect of my investments in the AFRF (Preservation Section). I acknowledge that FPC does not act as agent of the AFRF (Preservation Section) or of Life. They have been appointed by me and act on my behalf as my agent. I confirm that the appointment of FPC relates only to the provision of ongoing advice regarding my investment choice within the AFRF (Preservation Section). FPC is not remunerated to give me advice as to the suitability of investing in the AFRF (Preservation Section). This appointment shall continue until I retire or transfer out of the AFRF (Preservation Section). I acknowledge that in the event that I wish to terminate this mandate, I will be required to transfer my monies in the AFRF (Preservation Section) to an alternate preservation fund. FPC shall obtain from me such detailed information as is necessary to enable FPC to effectively and properly ascertain my investment requirements. FPC shall compile an investment strategy for me, taking into account my particular investment requirements. FPC shall inform me of such legislative, tax and investment considerations, as FPC might reasonably believe I ought to be aware of, in order to make an informed decision in respect of my investment in the AFRF (Preservation Section). FPC shall act strictly in accordance with my instructions and shall implement my instructions efficiently and with due diligence. I authorise the AFRF (Preservation Section) to remunerate FPC for the provision of their ongoing advice by a fee equal to 0,75% per annum (VAT exclusive) and further require FPC to provide to me a full disclosure of all remuneration or commission received. 10. FPC shall document all decisions taken by me and the reasons thereof. 11. The terms of the FPC mandate are confined to the terms contained herein, or such further terms as may be agreed between myself and FPC, and that FPC shall provide me with advice only with regard to my investment portfolio within the Retirement Fund (Preservation Section). By my signature hereto, I confirm that I have read and understood the provisions of (A) and (B) above and that I agree that to be bound to AF Life Limited and Financial Planning Consultants (Pty) Ltd, respectively, on the terms contained therein. Member s signature Date
Part B TRANSFER TO A RETIREMENT ANNUITY, PRESERVATION FUND OR YOUR NEW EMPLOYER S RETIREMENT FUND TRANSFER TO A RETIREMENT ANNUITY, PRESERVATION FUND OR YOUR NEW EMPLOYER S RETIREMENT FUND I elect to transfer my withdrawal benefit to a Retirement Annuity, a Preservation Fund other than the Retirement Fund (Preservation Section) by completing and signing the section below. In selecting this option I acknowledge the following: 1. I have read and understood the Options on Withdrawal brochure, copies are available at the offices of or my Employer; Agree Disagree 2. 3. 4. 5. I have obtained professional financial planning advice to ensure that this product meets my needs; I acknowledge that if part of the benefit is taken in cash to settle a Section 37D deduction in so far as it relates to Divorce / Maintenance Benefits, then the balance of the benefit may be transferred to a registered Preservation Fund and the deduction will not be regarded as a first withdrawal. For any other 37D deductions e.g. housing loan, dishonesty, fraud, etc., the deduction will be regarded as a first withdrawal. I have attached a copy of my ID document or passport; I acknowledge that should I disagree with any of the above statements, or should this form not be completed in full, my transfer will not take place. Member s Signature Date TRANSFER TO RETIREMENT ANNUITY, PRESERVATION FUND OR THE NEW EMPLOYER S RETIREMENT FUND If the benefit is to be transferred to a Retirement Annuity, Preservation Fund or the new Employer s Retirement Fund, attach a copy of the Application Form. Name of Fund/Insurer Policy/deposit reference FSB registration number 1 2 / 8 / SARS approval number 1 8 / 2 0 / 4 / Broker s name Broker s e-mail address Broker s telephone number C O D E N U M B E R Cell Banking details of receiving fund Account holder s name Account number Branch code Type of account Current Savings Transmission Name of bank Name of branch Failure to complete the above in full may result in a delay in settlement of this claim. Should we be required to settle indebtedness, the transfer of the balance of the benefit in accordance with the above instructions will be delayed.
Part C CASH BENEFIT CASH BENEFIT I elect to take my withdrawal benefit in cash (in full or in part) by completing and signing the section below. In selecting this option I acknowledge the following: 1. I have read and understood the Options on Withdrawal brochure, copies are available at the offices of or my Employer; Agree Disagree 2. 3. 4. 5. 6. I have been made aware that by electing a cash withdrawal benefit I may be negatively impacting on my ability to achieve an adequate retirement benefit at retirement age, and I have assessed that impact using the Retirement Projection Tool; I have been made aware that professional financial planning advice is available to assist me with my decision; I have been made aware that tax will be deducted from my cash withdrawal benefit, as will any outstanding Homeplan loan, or any employer request for a Section 37D deduction from my withdrawal benefit, or should there be a divorce or maintenance order against my Fund Credit; I have attached a copy of my ID document or passport; I acknowledge that should I disagree with any of the above statements, or should this form not be completed in full, my cash withdrawal benefit will not be paid. Member s Signature Date CASH BENEFIT If all or a portion of the benefit is to be paid to the member, please ensure that the banking details section below is completed in full. Please Note: Ensure that the bank account details supplied are in respect of member s own account. Banking details of receiving fund Account holder s name Account number Branch code Type of account Current Savings Transmission Name of bank Name of branch Failure to complete the above in full may result in a delay in the settlement of this claim. If part of the benefit is taken in cash and the balance transferred, the balance of the benefit may not be transferred to the AFRF (Preservation Section) or another Preservation Fund (in terms of SARS circular RF1/98), it must be transferred to a retirement annuity or your new Employers Fund. Please specify the amount to be taken in cash (if the full benefit is not being taken in cash): R, (Note: tax will be deducted from the amount prior to payment)
Retirement Fund (Preservation Section) Disclosures 1. The Retirement Fund (Preservation Section) comprises two separate registered preservation funds, the registration details are as follows: Retirement Fund (Pension Preservation Section) Reg. no. 12/8/37525 Retirement Fund (Provident Preservation Section) Reg. no. 12/8/37523 2. Transfers into the AFRF (Preservation Section) unless the administrators receive an instruction to the contrary, your withdrawal benefit will remain invested in the same portfolio as in the Retirement Fund; should you want your withdrawal benefit to be invested in another investment portfolio, an AFRF switch instruction must be completed and submitted together with this withdrawal notification; any money invested in a Guaranteed portfolio or in the Fullvest portfolio will automatically be switched into the Banker portfolio and will remain there until such time as you complete and return an AFRF (Preservation Section) switch instruction; Any amount used to settle an outstanding HomePlan loan (unless the HomePlan loan is continued in the Umbrella Preservation Fund) or an amount payable to your employer in terms of section 37D of the Pension Funds Act, will be deducted from your transfer value. This deduction (except divorce/maintenance order payments) will be regarded as your one withdrawal allowed from the Umbrella Preservation Fund in terms of legislation. Please note that tax will be payable on the outstanding HomePlan loan or amount deducted in terms of section 37D of the Pension Funds Act. 3. Investments unless the administrators receive an instruction to the contrary, your withdrawal benefit will remain invested in the same portfolio as in the Retirement Fund; you may elect to invest in any of the investment portfolios offered by the Trustees, details of the investment portfolios on offer are available in the AFRF (Preservation Section) brochure or on the AFRF website https://www.alexanderforbesonline.co.za; you are encouraged to obtain professional financial planning advice before selecting an appropriate investment portfolio. 4. Fees an ongoing annual management fee will be levied on your Fund Credit monthly and will be calculated as follows: 0,75%* p.a. of the first R250 000 of Fund Credit 0,5%* p.a. of the next R500 000 0,25%* p.a. of the next R250 000 0,225%* p.a. thereafter subject to a minimum fee of R15.00* p.m. * These fees exclude Vat there is a 1,14% per annum inclusive policy fee which will be deducted monthly from the investment returns earned on the investment portfolio. Certain specialised investment portfolios may have a higher investment policy fees (these higher fees will be communicated to you in the event that you elect to invest in them, alternatively details are contained in the AFRF (Preservation Section) brochure); switches between the investment portfolios will attract a 0,15% (excl Vat) of Fund Credit switch fee; there is an ongoing advice fee of 0,75% p.a. (excl Vat) of your Fund Credit which will be payable monthly; these fees may be amended from time to time at the discretion of the administrators, any such changes to the fees will be communicated to members three month prior to implementation. 5. Retirement Benefits in the event that you are not employed, you may apply to receive a retirement benefit from the AFRF (Preservation Section) at any time after the age of 55. You must take a retirement benefit by no later than age 70; if you are employed, you may only receive a retirement benefit from the AFRF (Preservation Section) at the same date as you retire from your employer; in the event of your retiring from the AFRF (Pension Preservation Section), you may take up to one third of your benefit as a cash lump sum (this amount is subject to tax). The remainder of your benefit must be used to purchase a compulsory annuity payable for life; in the event of your retiring from the AFRF (Provident Preservation Section), you may take the full benefit, or a portion as a cash lump sum (this amount is subject to tax). Any amount not taken in cash must be used to purchase a compulsory annuity payable for life; in the event of you becoming disabled, the Trustees of the AFRF (Preservation Section) may grant you an ill-health early retirement benefit equal to the value of your Fund Credit. on receipt of a retirement notification and provided the information is in order, the monies will be disinvested and switched to an interest-bearing account within four working days. if is unable to process the claim due to outstanding information, all documentation will be destroyed after three months. New documentation will have to be submitted after this date.
6. Death Benefits in the event of your death, the Trustees will distribute your death benefit (equal to your Fund Credit) in accordance with the provisions of Section 37C of the Pension Funds Act. 7. Withdrawal Benefits you may elect to take a once-off cash withdrawal from the AFRF (Preservation Section) of all or part of your benefit at any time, provided you have not already received (or have been deemed to have received) a partial withdrawal benefit (e.g. on settling a Homeplan loan on transfer, or on defaulting on your Homeplan loan repayments if applicable). Please note that if you have an outstanding Homeplan loan you must use a portion of this once off withdrawal to settle your outstanding Homeplan loan in full. This once off withdrawal benefit will be taxed; once a partial cash withdrawal is taken, the remainder of your Fund Credit must remain invested in the AFRF (Preservation Section) until retirement (unless you elect to transfer to another preservation fund - refer below). Taking a partial cash withdrawal may also affect the tax-free portion you are able to take when you eventually retire; once your full Fund Credit has been paid to you, this will represent a full and final settlement of any and all amounts owing to you and the Fund, Trustees, Principal Officer, and shall thereafter have no further liability towards you or any of your beneficiaries. in terms of current legislation, should you withdraw from one fund, you may not retire from another fund at the same time. on receipt of a withdrawal notification and provided the information is in order, the monies will be disinvested and switched to an interest-bearing account within four working days. if is unable to process the claim due to outstanding information, all documentation will be destroyed after three months. New documentation will have to be submitted after this date. transfers out of Fullvest could be subject to a penalty/market value adjustment. 8. Transfers out of the AFRF (Preservation Section) should you so wish, you may transfer your benefit in the AFRF (Preservation Section), to a new employer fund, or another preservation fund at any time prior to your retirement; any once-off withdrawal you have made from the AFRF (Preservation Section) will be advised to the new preservation fund, and you will not be allowed to withdraw from that fund prior to retirement; any transfer out of the AFRF (Preservation Section) is required to comply with the provisions of the Pension Fund Act; 9. Compliance Dept. details Aflife.compliance@aforbes.co.za
General Disclosure Notice to Life Ltd Clients as at 1 April 2009 Mission & Commitment mission is to be a truly diverse South African company drawing upon the depth and breadth of our committed, talented people to deliver pioneering, practical advice in retirement funding, personal financial planning, insurance, healthcare and related services, thereby improving the financial wellbeing of all the people whose lives we touch. We are in the business of helping clients build and protect assets and we do this by providing administrative platforms, by providing advice and by offering clients appropriate solutions to their different long term financial security needs. Life Limited ( AF Life ), is an authorised Financial Services Provider in terms of the Financial Advisory and Intermediaries Services Act ( FAIS Act ). As part of AF Life s commitment to render financial services with honesty, fairness, due care and diligence and to meet the requirements of certain disclosures in terms of FAIS, the following general disclosures are provided for your information and review. AF Life warrants that any AF Life Representative (as defined in the FAIS Act) who provides financial services to clients on any Financial Product complies with the fit and proper requirements in terms of the FAIS Act. AF Life will advise its clients of all instances where financial advice will be rendered by a registered representative under supervision of another registered representative. Financial Service Provider s Contact Details Details of Life Ltd Life Limited : Registration Number 1997/022561/06 Financial Services Board (FSB) / Financial Services Provider (FSP) Licence Number : 1178 Head Office Physical Address: Postal Address: Switchboard Telephone Number: Place PO Box 787240 (011) 269 0000 61 Katherine Street Sandton Sandown 2146 2196 Queries & Complaints: Compliance Officer s Details: Contact Centre Margaret van den Berg PO Box 787240, Sandton, 2146 Telephone Number : (011) 269 1727 Telephone Number : 0860-606162 Fax Number : (011) 263 1731 Email address : fshelp@aforbes.co.za Email address : complianceofficer@aforbes.co.za Queries and complaints may be addressed to our Contact Centre (details above). Access to the complaints procedure and forms may be obtained from your contact person, the Contact Centre, those with access to AF Online or http://www.alexanderforbes.co.za/africa/fais/fais.htm. If any complaint to AF Life is not resolved to your satisfaction, you may submit your complaint to the relevant Ombud s office. Contact details of the relevant Ombud offices are included in the complaints procedure. Declarations AF Life is licensed for Category I (rendering of Financial Services). The full sub-category details are provided on your Representative s Disclosure. A copy of our FSP licence certificate and the conditions of the licence is available on request from your representative or the FSP. AF Life s duties and obligations will be specified in the clients Services Agreement / Mandate or where agreed in writing by the parties. Unless otherwise agreed, AF Life shall provide Financial Product information on those Financial Products with which it is familiar and which are adequate and appropriate in the circumstances and shall not be obliged to provide details of every product which might potentially meet that need. Without in any way limiting and subject to the other provisions of the Services Agreement/Mandate, AF Life accepts responsibility for the lawful actions of our representatives (as defined in the FAIS Act) in rendering financial services within the course and scope of their employment or mandate. Where providing advice in relation to financial products, AF Life is required to analyse its clients requirements and needs. The financial advice provided by AF Life will be based on the information provided by the client. AF Life will not be held liable for any financial advice that was provided in respect of incorrect, inaccurate or incomplete information provided by the client. AF Life may keep records of verbal and/or written communication with its clients as pertains to the financial advice rendered to that client. AF Life has secured Professional Indemnity and Fidelity Insurance. AF Life does not derive more than 30% of its total remuneration from any one product supplier. AF Life does not directly or indirectly hold more than 10% of the relevant product supplier s shares, or has any equivalent substantial financial interest in the product supplier Where required in terms of the Financial Intelligence Centre Act (FICA), AF Life shall be obliged to record and verify client information in the manner prescribed in FICA. AF Life may also be required to report unusual and suspicious financial activities where so obligated by FICA. AF Life may be unable, in particular circumstances and where required by FICA, to process the transaction as required by the client, unless the identification and verification requirements in terms of FICA are met. AF Life cannot be held responsible for a failure to action any transaction, where such failure was as a result of the non-provision of the legislated information as required by FICA by the client. It should be noted that senior individuals within AF Life may receive bonus remuneration which recognizes their contribution to the financial success of AF Life or the wider Group. AF Life has a gift policy that aims to prevent any situation that could create an impression of conflict with a client s interest or compromise the Company s independence from suppliers. In the event that there is a potential conflict of interest in any financial advice offered to its clients, AF Life shall at all times place the interest of its clients before its own. In providing financial services to its clients, certain business may flow to other companies within the wider group. AF Life benefits to the extent that business is retained within the group. An Inter-Company Structure has been provided on the following page to reflect the various business relationships. Certain subsidiaries have not been detailed on the Inter-Company Structure and in the event of business flowing to any of these subsidiaries; a separate disclosure will be made in this regard.
South Africa Holdings (Pty) Ltd Financial Services Holdings (Pty) Ltd Financial Services (Pty) Ltd FSP No. 1177 83% Seniors Finance (Pty) Ltd Inter-company structure (excluding dormant companies) Limited Risk Insurance Services (Pty) Ltd Group & Technology Services (Pty) Ltd Investment Solutions Holdings (Pty) Ltd Afrinet Investments (Pty) Ltd Group Jersey Ltd (Jersey) International Ltd (UK) Life Ltd FSP No. 1178 FIHRST Management Services (Pty) Ltd Health (Pty) Ltd FSP No. 33471 HomePlan (Pty) Ltd Retail Holdings (Pty) Ltd Fiduciary Services Ltd Financial Planning Consultants (Pty) Ltd FSP No. 31753 Individual Client Adminitration (Pty) Ltd) FSP No. 32494
Retirement Fund (Provident & Pension Preservation Sections) Application for HomePlan Loan Transfer Part A Requirements for transfer of a HomePlan Loan from your existing fund into the AFRF (Provident or Pension Preservation Section) 1. If you have already exercised, or are planning to exercise your onceoff withdrawal, or will be deemed to have made a once-off withdrawal to, for example, pay a Section 37 D deduction prior to transfer, you will not be able to transfer your HomePlan Loan to the Preservation Section. 5. Should you default on the terms of your HomePlan Loan, HomePlan reserves the right to call up your outstanding loan and request settlement from the Preservation Section. This settlement will constitute your once-off withdrawal and no further withdrawals, other than your retirement benefit, will be allowed from the Preservation Section. 2. You can only transfer your outstanding HomePlan Loan from an existing HomePlan facility into the Preservation Section facility if, upon transfer, the loan will not exceed 50% of your withdrawal benefit calculated as at the date of your exit from your existing fund. Please note that your benefit is calculated after making provision for tax or any other amounts payable on withdrawal. Please note that no tax is actually payable on transfer - this is a theoretical calculation. 6. In this regard, please pay particular attention to the amendments to your existing agreement, as detailed below. Monthly repayments on your loan account will be made by direct debit from your bank account. For this purpose you will need to complete the Debit Order Instruction Form shown under Part C to this application for transfer. 3. 4. If your outstanding HomePlan Loan exceeds 50% of your withdrawal benefit as calculated above, you must either settle your outstanding loan in full; or settle the portion of the loan in excess of the 50% out of your own private funds so that the balance of the loan can qualify for transfer to the Preservation Section. This application needs to be completed and processed within one month of your date of application to transfer your benefit to the Preservation Section; failing which your application may be rejected. Delays in this regard could affect the transfer of your Fund Credit to the Preservation Section, which could in turn affect investment returns earned during this period. 7. Your repayment period and/or instalment amount may change as result of the transfer to the Preservation Section. You will receive written notice detailing any changes. Interest will be calculated at Prime, unless your loan amount exceeds R100 000, for which a rate of Prime less 1% will apply. A monthly service fee of R5,70 will apply and will be added to the required repayment amount. As per your original loan application form interest rates and service fees are subject to change. Part B To take effect to the above the following terms and conditions of your existing HomePlan housing loan agreement will be replaced or added to as follows: Part G: 3.6 Fund means the Retirement Fund (Provident Preservation Section) and Retirement Fund (Pension Preservation Section). NOTE: the guarantor has changed. 5.2 The Manager shall be entitled to deduct the monthly instalments due in terms of this agreement from the Borrower s bank account by means of a debit order. The Borrower hereby irrevocably authorises the Manager to obtain a debit order for the purposes of deducting the monthly repayments due to the Joint Venture in terms of this agreement. The Borrower shall not terminate such authorisation until the principal debt and all interest due thereon has been paid in full. NOTE: payroll deductions are no longer applicable. The Joint Venture, between ABSA Bank and, is the entity lending you the money. 11.1 The Borrower s membership of the Fund is terminated for any reason whatsoever. NOTE: reference to the employer has been removed 11.6 If the full amount of the outstanding loan, including interest, at any time becomes equal to or greater than seventy five percent of the value of the minimum benefit [net of income tax as envisaged in section 37D(a) of the Pension Funds Act] that the Borrower would receive if he were to terminate membership of the Fund voluntarily. NOTE: this is a new default clause. 14 The Borrower hereby chooses domicilium citandi et executandi at the Borrower s address as specified in PART A above. Any notice given by the Joint Venture in terms of the agreement shall be addressed to the Borrower at his chosen domicilium citandi et executandi. Notices which are posted shall be irrefutably deemed to be received by the Borrower 5 (five) working days after posting. NOTE: the address provided on your debit order instruction form will be used where it is different to that which was provided on your original application form. 15.3 The Borrower hereby authorises the Joint Venture to disclose details related to this agreement to the Fund. NOTE: reference to employer has been removed. The clauses shown below are new: 16 Full Debt Immediately Due and Payable 16.1 The full amount outstanding, including interest, shall become immediately due and payable by the Borrower to the Joint Venture if the Borrower instructs the Fund to pay any benefit to him. 17 Authorisation to Effect Once-Off Withdrawal 17.1 If any of the circumstances referred to in paragraphs 11.1, 11.2, 11.3, 11.4, 11.5 or 11.6 exist, then the Borrower agrees that he will, on request by the Joint Venture, immediately instruct the Fund to pay him the once-off withdrawal to which he is entitled. The Borrower will, in these circumstances, ensure that the amount of such post-tax onceoff withdrawal is at least sufficient to fully settle the outstanding balance due in terms of the agreement. The Borrower acknowledges that the Fund will settle the full balance outstanding to the Joint Venture, prior to paying out the residual balance. Should the Borrower fail, for any reason whatsoever, within five days of such request having been made, to instruct the Fund to effect settlement of the outstanding debt to the Joint Venture, then the Borrower hereby irrevocably authorises the Manager to issue such instruction to the Fund on his behalf. 17.2 If the Borrower issues an instruction to the Fund as contemplated in paragraph 17.1 above, then the Borrower shall ensure that the amount of the requested post tax once-off withdrawal is at least sufficient to settle the full loan amount outstanding [inclusive of interest]. The Borrower agrees that the portion of the post-tax once-off withdrawal amount that is necessary to fully settle the loan in terms of this agreement will be paid by the Fund directly to the Joint Venture. 18 Consequences of the Once-Off Withdrawal The Borrower acknowledges that he is aware that if any withdrawal is made from the Fund, either on the Borrower s instructions, or by the Joint Venture or the Manager in terms of this agreement, then no further withdrawals, other than on retirement, will be permitted to be made from the Fund under any circumstances. On signing below I acknowledge that I have read and understood the conditions detailed above and where necessary, made the relevant enquiries.
Part C Debit order instructions Name & surname Identity document no. Dialling code & telephne no. (W) Dialling code & telephne no. (H) Cell phone no. Postal address Postal code Email: Banking details Bank Branch name Brance code Account type Savings Current Transmission Account no. I, (insert name) agree, instruct and authorise HomePlan to draw against my account with the above mentioned bank (or any other bank or branch to which I may transfer my account) an amount, as to be confirmed to me in writing by HomePlan, until my HomePlan Loan is paid in full. All such withdrawals from my bank account by HomePlan will be treated as though I signed them personally. The amount to be withdrawn is necessary for the payment of the monthly instalment due in respect of my outstanding HomePlan Loan and will be deducted from my account on the 28th day of every month (following my signature of this authority) until my HomePlan Loan is paid in full. I understand and agree that the withdrawals hereby authorised will be processed by a computer through a system known as FIRHST connect. I agree to pay any bank charges relating to this debit order instruction. Should this debit order be returned for what ever reason, I will pay the additional bank charges relating to the reversal. The authority can only be cancelled by me once the HomePlan Loan has been paid in full, or alternative arrangements have been made in writing. I indemnify and hold HomePlan and FIRHST (divisions of Group (Pty) Ltd) harmless for any loss or damage that may be occasioned by the negligence or fraud of my bank, and am aware that by this indemnity I have not extinguished any rights as I may have directly against my bank. I acknowledge that the party hereby authorised to effect the drawing against my account may not cede or assign any of its rights to any third party without my prior written consent and that I may not delegate any of my obligations in terms of this contract/authority to any third party without prior written consent of the authorised party. NOTE: Proof of banking details needs to be provided in the form of an original or certified copy of a bank statement, or a cancelled cheque. Signed on this day of 20 Signature of Borrower/Account holder Mar2006-AFRF Preservation loan transfer application